A case of mesh infection after robotic-assisted laparoscopic sacrocolpopexy (RASC) in which robotic-assisted laparoscopic mesh resection was performed, and infection was successfully controlled despite incomplete mesh removal.

Abstract

We report a case of a 50-year old woman who developed fever and abdominal pain 11 days after undergoing robot-assisted laparoscopic sacrocolpopexy (RASC) for rectocele using a double-mesh ORIHIME. She was admitted to the hospital 14 days postoperatively due to a suspected mesh infection, and antibiotics were administered. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed a pelvic abscess without evidence of spondylodiscitis or osteomyelitis. Robot-assisted laparoscopic mesh resection was performed under the diagnosis of a pelvic abscess caused by mesh infection. Intraoperatively, pus was discharged from the cervical stump and the mesh fixation site after peritoneal incision, and the culture results revealed the presence of Enterococcus avium. The mesh fixed to the anterior and posterior vaginal walls was removed; however, the mesh attached to the sacrum could not be removed due to adhesions. Postoperatively, fever subsided on the fourth day, abdominal pain improved on the fifth day, and the patient was discharged from the hospital on the 11th day. No evidence of infection recurrence has been observed since. Although the rectocele returned to its preoperative state, the patient did not wish to undergo reoperation and has been monitored. Infection in the mesh after RASC requires removal of the mesh; however, if the mesh is not removed in a non-infected area, the infection may still be adequately controlled, as demonstrated in the current case.